Conization: Indications, Techniques, Complications.

Conization is a surgery that in recent years has been subjected to major technical improvements which on the cervixone hand led to a reduction in recovery time and complications and in the other to better results in the removal of lesions and diagnostics.

The cervix is placed in the lower part of the uterus and directly borders the top of the vagina. an anatomical structure is very important not only from the cancer standpoint (cervix cancer is still one of the most common female cancers) but also from the reproductive standpoint because through this structure, capable of undergoing important morpho-functional changes, pass (and make it active) sperm for fertilization, menstrual flow and the fetus at childbirth.

Conization consists in the excision of a portion (usually conical, hence its name) of the cervix in order to remove a potentially malignant lesion but still very limited in its extension. can therefore be considered conserving surgery because it does not substantially affect the architecture and physiology of the uterus at the same time is therapeutic and diagnostic.conization

Usually the indication for this surgical procedure comes from surveys such as the Pap Test, Colposcopy and biopsy (sample of tissue) carried out under colposcopic guidance. The application of extensive screening programs to all women of reproductive age and in the first decades after the menopause has made it possible to capture increasingly early malignant lesions of the cervical emphasizing the role of this intervention feasible with due attention both that in the Day Surgery and in the ambulatory practice.

Cervical cancer (we’ll talk extensively in other sections of the site) has viral origin (Human Papilloma Virus, HPV) and its latency time required between infection (sexually) and the development of an invasive form of cancer opens a “window” in which the screening protocols (pap test), diagnostic (colposcopy, biopsy) and cone biopsy (removal of the lesion) have had and still have a vital role in reducing mortality.

Born as an intervention aimed at preserving the anatomical integrity of the uterus and cervix, Conization has maintained this target by acquiring more and more increased security both in terms of therapeutic and of complications. Excision by LEEP (Loop Electrosurgical Excision Procedure), CO2 laser excision and cold knife (traditional surgery) are the most used techniques.

COLD KNIFE surgery is the classic surgical conization: after a careful cytology, colposcopy, biopsy and if necessary hysteroscopic evaluation, a conical portion of the cervix is removed with a scalpel by modulating the extent of demolition on the basis of nature and location of the lesion. A brief hospitalization is required. Hemostatic stitch are required and, in any case, there are frequent bleeding both during and after the surgical procedure.

The cervix immediately after surgery.

The cervix immediately after surgery.

In the LEEP a high-frequency diathermy loop allows a rapid performing cone biopsy with minimal intra-and postoperative complications. In particular, bleeding is minimal and the “Restitutio ad Integrum” (return to its original appearance) of the cervix after a few months is very satisfactory. This method respects the Cervix anatomy and function but has some limitations, mainly related to the possible tissue thermal damage that can sometimes hinder the microscopic reading of the removed cone margins (cervical tissue) and in the impracticability of cervical canal deep extension lesions which it is suspected an initial invasiveness.

LASER Conization is quick and very accurate; it provides a histological non-artifact and therefore easily legible.This technique is characterized by very little complications and the final appearance of the cervix is very good with a “Restitutio ad Integrum” almost perfect. This method however has the disadvantage of being very expensive and requires a considerable degree of training of the operator.

ELECTROSURGICAL RESECTION (or electro-conization) with needle or spatula is a viable alternative to “cold knife”, loop diathermy or laser surgery. It is cheap and simple. The cone that is obtained is accurate, artifact-

Uterine Cervix Cone sectioned at 12 pm. Operative findings.

Uterine Cervix Cone sectioned at 12 pm. Operative findings.

free. “Restitutio ad Integrum” is great and there are minimal complications.

These measures should always be carried out under colposcopic guidance. The anesthetic techniques can be of different types (local and general) and depend on clinical considerations related to the patient. In addition to bleeding complications, there may be infections, scarring stenosis and cervical incompetence in pregnancy (increased risk of miscarriage and premature birth).

The conization should be considered as safe and very often decisive intervention. Faced with one of the current available techniques, ensures a successful conservative attitude both towards the uterine cervix and the entire body, in particular preserving the reproductive capacity of the patient.

It is recommended to abstain from sexual intercourse for about a month after surgery. Therapy at hospital discharge vary according to the techniques used, the beliefs of the operators and the clinical needs of patients.

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Filiberto Di Prospero
Medical Doctor, Consultant in Gynecology and Obstetrics, Endocrinology and Metabolism. Director of Gynecologic Endocrinology Unit at Civitanova Marche General Hospital (Italy). Private clinics in Civitanova Marche, Rome and Milan.

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